The 21st Century Cure Act requires, as a condition of participation in any Medicaid Managed Care Plan (MMCP) that the applicable provider, including pharmacies, be enrolled in the state Medicaid plan. The New York Office of the Medicaid Inspector General (OMIG) has notified plan sponsors that, as effective July 1, 2018, they must terminate providers that are not enrolled in Medicaid. This means that pharmacies that are not enrolled will be terminated by PBMs from participating in MMCP.
In recent weeks, Frier Levitt has received an alarming number of calls from pharmacies who have attempted to enroll in New York Medicaid that their applications for enrollment are being denied by OMIG for somewhat dubious reasons. Attempts at appealing these rejections through OMIG’s appeal process are frequently futile and leave pharmacies with few alternatives, other than litigation, once these administrative remedies have been exhausted.
If you are a New York pharmacy dealing with state Medicaid issues, contact Frier Levitt to speak to an attorney. Frier Levitt has developed a variety of litigation strategies are prepared to file suit against New York State to prevent termination of pharmacies from the MMCP.
